| Bennett P Hogan Md Pc | |
|
117 W Northside Dr Valdosta GA 31602-1700 | |
| (229) 333-0616 | |
| (229) 333-0647 |
| Full Name | Bennett P Hogan Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 117 W Northside Dr, Valdosta, Georgia |
| Authorized Official Name and Position | Bennett Pate Hogan (PRESIDENT) |
| Authorized Official Contact | 2293330616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bennett P Hogan Md Pc 117 W Northside Dr Valdosta GA 31602-1754 Ph: (229) 333-0616 | Bennett P Hogan Md Pc 117 W Northside Dr Valdosta GA 31602-1700 Ph: (229) 333-0616 |
| NPI Number | 1134184864 |
|---|---|
| Provider Enumeration Date | 04/18/2006 |
| Last Update Date | 03/19/2013 |
| Medicare PECOS PAC ID | 6608828637 |
|---|---|
| Medicare Enrollment ID | O20050217000430 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134184864 | NPI | - | NPPES |
| 000906177A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 050024 (Georgia) | Primary |
| Provider Name | Bennett P Hogan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205891397 PECOS PAC ID: 2769434794 Enrollment ID: I20050217000468 |
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